In a passive test for suspected medial epicondylitis, which position is used to elicit pain?

• A. Elbow extended, stretch into wrist extension and supination
• B. Elbow extended, stretch into wrist flexion and pronation
• C. Elbow flexed, stretch into wrist extension and supination
• D. Elbow flexed, stretch into wrist extension and pronation

Answer: (A)

Medial epicondylitis pain comes from overuse of the common flexor tendon at the medial epicondyle. To reproduce that pain with a passive stretch, you lengthen the tendons crossing the elbow and wrist. Positioning the elbow straight places the flexor-pronator origin under tension across the elbow, then extending the wrist further lengthens the flexor tendons as they cross the wrist. Keeping the forearm in a neutral to supinated position minimizes pronator involvement and focuses the stretch on the medial flexor origin. This combination—elbow extended, wrist extended, forearm supinated—stresses the offending structures and is most likely to reproduce the painful response when pathology is present. If the elbow were flexed or the wrist not extended, the tendons would be less stretched and pain might not be elicited; pronation instead of supination can shift tension toward other muscles, making the test less specific for the medial flexor origin.